Matthew Taylor's keynote speech at NHS ConfedExpo

Here at this amazing event, I couldn’t be prouder of leading the NHS Confederation. 

But as those of you who know will be aware I have a somewhat fragile ego.

It doesn't take much to knock me.

Like this morning. Penny Dash finished her speech by reminiscing. She recalled her first public speech more than 30 years ago

She said: “Then, I didn’t have many wrinkles but I was hopelessly naïve”

‘Ah,’ said a Confed colleague unfortunately in ear shot, ‘sounds just like Matthew’ 

If you want skin cream tips, ask me afterwards 

But there are compensations to getting older. Eventually your clothes will come back into fashion. You can dust off your vinyl records. Your age-adjusted Parkrun rating might improve. 

Being older also provides perspective. 

I am sceptical when people say things have never been so bad – I remember the seventies. 

I can also recall the last time it seemed a major Party might dismantle the NHS. There were many people around Margaret Thatcher who were keen. She introduced limited tax breaks for private medical insurance. But despite her ideological perspective, Mrs T was a pragmatist. She knew public support for the NHS was so strong that to break it up would be political suicide. 

"The next general election could see one or more major party with a credible chance of forming the next government openly sceptical about the NHS"

The NHS in the 1980s faced many challenges and radical reform but public trust in the service remained high. 

That, as we all know, has now changed disastrously.

The next general election could see one or more major party with a credible chance of forming the next government openly sceptical about the NHS. Their leaders may make the judgment that voters are so despairing of the service they are willing to see it become a mere safety net, perhaps by incentivising even more people to do what many are doing already, buying medical services from the market. 

If that happens, we know what follows. As Nye Bevan said: ‘a service for poor people becomes a poor service.’

The NHS is used to fighting for the lives of its patients. It’s what you and your staff do every day. 

But now we are fighting for the life of the NHS as a universal service available according to need. 

And it is a daunting challenge. 

For this is a fight we must win in the most challenging of circumstances. Wes Streeting is to be applauded for negotiating hard for the NHS in the CSR, but we know the national context, the pressure on all public services and on family finances. As far as we can see into the future we face a tough financial environment. 

"...while satisfaction with the service declines, public expectations rise"

Already our leaders tell us that you are having to make very difficult decisions, ask even more of your staff, cut back on services, accept higher levels of risk. That issue of risk is particularly challenging in mental health.

And yet while satisfaction with the service declines, public expectations rise. From weight loss to cancer, people want access to the new treatments they read about daily. 

They experience the best the retail sector has to offer in speed, personalisation, reliability and they ask why the NHS lags so far behind. 

The ten-year plan will be eloquent I’m sure on the possibilities of med tech, biomedicine, AI. Futurists have long predicted a world where genetic profiling, smart diagnostics and wearables mean we no longer wait for symptoms to identify and respond to potential disease. That world is now just around the corner. 

The plan needs to make some big bets on the future in the NHS supporting the desire of the public to take charge of their own health. 

For example, outpatient services should and could be transformed with most checks and follow ups done in neighbourhoods or remotely.

Innovation has the scope to reduce costs and boost productivity, but history tells us that technological possibility and patient power will also generate new demands and expectations. 

The challenge with technological innovation is not describing what might be possible. It is how we create a better future when we start from a capital-starved NHS and outdated systems and regulations that make innovation and spread much harder than it ought to be. 

As an acute leader from the north west said to me just last week, it is difficult to be inspired by predictive medicine and AI clinicians when you are working in a trust that hasn’t even got an electronic patient record. 

One of the Confed’s answers to this question is that we need to bring more private investment into the NHS. I’m proud of the influential work we have done in this space. It’s clear from the CSR that if we have to rely on Treasury capital funding alone it is very hard to see how we can reform at pace. 

Speaking of innovation, our magnificent Expo exhibition is full of exciting innovations and enthusiastic potential partners. So please do spend time there. You have after all abandoned your family to be here; the least they should expect is more writing pads, branded pens and strangely shaped stress balls.

From analogue to digital is one of the three shifts that underpin the ten-year plan but I want to focus more on the other two – which are really one. 

How do we get better at helping people avoid, cure and manage illness, and in doing so reducing unnecessary demand for treatment and particularly hospital-based activity? 

In this we are not succeeding. In many ways the health of the nation has deteriorated. We are living longer but not healthier. 

The shift over recent decades has been rightward not leftward.

As The King’s Fund reported just last week:  

‘Current models of care based on isolated care plans and siloed service pathways lead to poorer experiences and outcomes for people and inefficiencies for service providers.’

What makes this failure most frustrating is that the good things we want go together. More joined up and personalised care increases patient satisfaction and engagement and reduces unnecessary acute demand.

"As I go round the country, I see the scope and the appetite to do things differently"

As I go round the country, I see the scope and the appetite to do things differently. 

Systems being innovative and creative like the brilliant dental school and clinic established in Ipswich by Suffolk ICB and University 

Trust leaders with teams working beyond their organisational boundaries, like some of the great work at place level I recently saw in West Hertfordshire 

Secondary clinicians like those participating in the pathway stewardship programme in Mid and South Essex eager to innovate, reaching out to work with colleagues outside hospital in the community and primary sector.

Primary leaders working at scale, hungry to do more and engaging richly with the communities they serve like Nigel Fraser’s team in Herefordshire or Neil Modha’s in Peterborough 

Mental health leaders working with independent and third sector providers to develop new models of care. Like the partnership between trusts from Teesside to Taunton and digital technology companies introducing AI across mental health pathways

By the way, Lorraine Matis CEO of the Suffolk dental CIC featured along with the Confed in the Financial Times and on the Today programme last Friday. This is just one of several member good practice stories we have placed in national media over the last year. That kind of impact is part of the offer we are now making through the Confed’s own communication agency, HealthCommsPlus, which is being launched here at Expo tomorrow – details on our stand.

"After decades of describing the problem and merely aspiring to solve it, this time needs to be different"

Everywhere I go in the NHS I see innovation and good practice. But too often it feels like the pioneers are using oars to try change the course of a cruise liner drifting towards the rocks.

After decades of describing the problem and merely aspiring to solve it, this time needs to be different. 

This time has to be different. 

So, as we await the ten-year plan the Confed has messages for our political leaders, for NHS England, for our members and for the public.

The theme running through these messages is that we must re-imagine the NHS, not as a hierarchy made up of separate organisations providing services that patients must try to navigate, but as an agile team of teams, building services around the needs, preferences and capabilities of citizens.

The first message is for ministers: The only route to regaining public trust and putting the NHS on a sustainable footing is fundamentally to change our model of care. 

"...how we fund services has to change. Moving from incentivising activity to incentivising outcomes"

Changing that model must be the ten-year plan’s core aspiration and achieving that change its core measure of success.

That is why how we fund services has to change. Moving from incentivising activity to incentivising outcomes. 

From short-term to multi-year funding; funding designed to reward the shift upstream and to reduce needless acute activity.

Funding designed to make different parts of the system work together and – let’s be frank - make life tough if they don’t. 

It is why neighbourhood health must be about ensuring that patients and their families feel empowered as partners; that services – including services outside the NHS – are brought together around people to help them solve their problems and take control of their health and their lives. Seeing localities not just as bundles of individual need but as communities with insights and assets to draw on and enhance. 

Speaking of teams, the ten-year plan must breathe new life into the idea of a health mission across government. Recognising and tackling the impact of alcohol, unhealthy food, gambling, social media. And also, crucially, the social determinants of illness in poverty, poor housing, debt. 

The fourth purpose of ICBs may regrettably have been set aside, but still, we in health need to fulfil our role as anchor institutions in local economies just as we need other parts of government, nationally and locally, to think about the health dimension to every policy. 

And our political masters must be clear about priorities and realistic about change. If the CSR means choices must be made about which manifesto promises can be delivered, then ministers need to be honest rather than resorting to magical thinking. 

NHS leaders will and should strain every sinew to combine recovery and reform but to demand the impossible does no one – least of all the public – any favours. 

To the leadership of NHS England my first message is to welcome a new tone. Sometimes in the past the NHSE account of the service was a jarring mixture of complacency and helplessness. I hear now a new honesty about where we are and a new determination to get to where we need to get to. 

Not that everything has gone well. 

There are many aspects of the ICB reorganisation process that have been guilty of a ‘shoot first, answer questions later’ approach. 

But while there is still a huge amount to do to avoid breakdown and risk, it was good to see the engagement of system leaders in the model ICB work and now in exploring how to make strategic commissioning work. 

The UEC delivery plan last week too had several welcome elements: Acknowledging the scale of the challenge, a commitment to reduce unnecessary bureaucracy, underlining the importance of collaboration. 

Under Jim and Penny there is a sense of a centre that is genuinely seeking to understand where it can add value and not to instruct or interfere where it can’t. 

But this needs to be sustained if trust and confidence are to be restored. In a survey of well over a hundred leaders from across the service, which we undertook last week, we found high levels of dissatisfaction with the way policy changes have been communicated, and a large majority feeling they are not listened to by central decision-makers. 

"But the need to transform our model of care requires us to focus more on collaboration"

Leaders recognise the importance of financial discipline, productivity, performance recovery. There are many good stories to tell, like the impressive increase in the last year in the number of people who say they have found it straightforward to access a GP. 

But the need to transform our model of care requires us to focus more on collaboration. 

I’ve spoken to several trust leaders who have told me that the pressure they face and the emphasis on organisational accountability leaves little energy, resource or incentive to work beyond their boundaries. 

This is a deep and inherent problem with the NHS. It is the main reason we haven’t delivered on the left shift and have failed to design services around patients. 

So whether it’s performance management, improvement or intervention, the centre must give as much attention to what happens between organisations as what happens inside them. 

This belief in the vital importance of collaboration across the service has shaped the growing portfolio of improvement and leadership development work undertaken by the Confed. 

Our successful national improvement programme on the primary secondary interface, the one we have recently started working with managers and clinicians in mental health and emergency departments. The work we have been doing with the Q community and the Health Foundation to develop an improvement model for system and place working. 

The leadership development we have done with local primary care providers.

Which takes me to a message for leaders. 

This is dangerous territory. After all, you pay some of my wages.

What right have I to challenge you when every day you face incredible pressure and do amazing work. For example, 200,000 fewer people on the elective waiting list since last year is no mean achievement. 

Because of your work and that of your teams, even though the public are worried about access they still generally rate the care they receive highly. 

So, it is with due respect and deference that I say, whatever the challenges of national policy, local leaders too must find ways of working better together. 

When I make my regular visits around the country, I see the ambition that Jim Mackey extolled this morning.

But I am too often told that transformative change is made more difficult by strained local relationships, even by what the UEC plan described as ‘blame shunting’, whether that is between parts of the service or with our local government colleagues. 

"It is vital that the operating model, financial systems and incentives frameworks in the ten-year plan drive integration"

I’m told about services that could be moved out of hospitals but that hospitals rely on that work to balance the books. 

That shouldn’t be a reality to succumb to but a problem we commit to solve. 

It is vital that the operating model, financial systems and incentives frameworks in the ten-year plan drive integration. 

The discussion locally on the operating model revealed in the ten-year plan should be what arrangements work best for patients not who can grab control. 

But ultimately, the depth of collaboration and the capacity of the service to work together for the benefit of places and patients depends on culture, on trust, and on relationships. 

United we deliver. Divided we fail. 

The Confed’s networks – acute, community, mental health, primary, ICS - support our members in those sectors but with a consistent focus on how we work together at all levels. 

Our duty is to our members, but we will not succumb to the tendency of membership organisations to sink to the lowest common denominator, only saying things everyone can agree about, always blaming others for our challenges. 

Part of our job is to create well-structured, positive spaces where our members can have challenging conversations. For example, about the performance variations that was another theme of Jim’s speech.

On that topic, I'm proud our Evolve Collaborative is now a reality. Evolve is a partnership with Australian Data Analytics company Beamtree. It will combine their expertise in data benchmarking and predictive analytics, with our ability to bring our membership together in learning communities.

If you'd like to know more please visit our Confed stand.

"The ten-year plan is also an opportunity for a message to the public. Yes, we need to commit to restoring satisfaction and trust. But we also need to be clear we cannot do this on our own"

The ten-year plan is also an opportunity for a message to the public. Yes, we need to commit to restoring satisfaction and trust. But we also need to be clear we cannot do this on our own. 

Access is a huge issue. People in pain and often unable to work while stuck on waiting lists. Hundreds of thousands struggling alone with deteriorating mental health, many of them children and young people. Twelve-hour waits and corridor care in emergency departments – an issue which the figures suggest may now be the biggest cause of public concern.  

But less discussed – at least openly - is that the service also has an over-supply and mis-supply problem. Significant sums of money are spent on medical interventions which deliver limited gains. This is partly about the treatments themselves, but also the very high rate of medical non-adherence. According to NICE between one-third and one-half of all medicines prescribed for long-term conditions in the UK are not taken as recommended.

Several factors are at play. There is a failure to recognise the importance of ‘decision points’ when patients can talk in depth about what ails them and whether more medical interventions are best for their wellbeing. As Victor said, asking patients the all-important question: ‘what matters to you?’

There is the challenge of accessing non-medical help, from welfare advice to family support. For example, the impressive neighbourhood team in East Birmingham told me on a visit recently that the service they most lacked was ‘befriending’.  

Reflecting the views, among others, of Wes Streeting, in the ten-year plan is bound to insist on it saying much about patient choices and rights. That story is important, but it should be balanced with one about a deeper, more honest relationship between the health service and the people who most need it. 

We can’t do everything.  We shouldn’t even try to do everything. A lot of what we can do, especially for those with long-term conditions, depends on patients’ expectations, attitudes and behaviours.

There are lots of ways we can fail to create a sustainable NHS which genuinely meets the needs of its users. 

But there is only one way to get it right. 

It needs the right political and policy leadership – ambitious, yes, but also honest and realistic.

It requires a centre that adds value, enables, listens, works in partnership. 

It needs leaders who focus yes on the success of their own organisation but just as much on the mission of patient-centred transformation

It needs a public which doesn’t just want us to do better but understands and embraces the ways they can help us to help them.

The Confed is committed to making this happen. As an organisation, guided by our members, backed by our members, focused on our members, we are growing in ambition, scope and confidence. 

But we at the Confed must ask ourselves hard question too. We must focus on what the service needs even if it challenges us or involves risks. 

It is in that spirit that when my good friend Daniel Elkeles – who is here today - was appointed CEO of NHS Providers we immediately leant out to each other.

We are committed now to bringing our organisations closer together. Doing that is complex and we need to avoid it from distracting us from supporting you in this utterly crucial period. 

But we have heard our members. 

We know what you expect from us. 

The next four years will be the most important years in the history of the NHS. 

If we get it wrong, they could be among the last years. 

I started by talking about those disturbing figures on public trust, but there is another statistic that is just as important: The public still overwhelmingly supports the founding principles of the National Health Service. 

They want us to get it right. 

And we must not let them down.